Background: Point-of-care ultrasound (POCUS) is a diagnostic tool that is being increasingly utilized within the hospitalist sector of internal medicine; however, there is currently no summative source of information for POCUS in perioperative medical management. To address this gap in knowledge, we conducted a systematic review of studies assessing the impact of POCUS on clinical outcomes of inpatient adults.
Methods: This study utilizes a systematic review design. The inclusion criteria for literature include adult patients, planned/performed surgical intervention, use of POCUS during evaluation, and studies with measured clinical outcomes. The following sources were searched on September 8th, 2022 to identify studies published in the past twenty years: Ovid, PubMed (MEDLINE), Scopus (Elsevier), and Web of Science. Query terms included: point-of-care, ultrasound, POCUS, adult, and perioperative. Abstracted data elements include specialty of ultrasound operator, organ system of interest, intervention, ultrasound parameter measured, and surrogate clinical outcome.
Results: Initial literature search resulted in 214 unique abstracts of which 17 studies were included with a total of 1904 patients (mean age of 57 years and 53% male). We found the specialty of the ultrasound operator to be anesthesia in 14 studies, cardiology in 1, surgery in 1, and nursing in 1. Organ systems assessed included cardiac (6 studies), pulmonary (3), gastric (3), vascular (1), hepatic (1), peritoneal (1), genitourinary (1), renal (1), and musculoskeletal (1). The ultrasound parameters and surrogate clinical outcomes varied by study and were not applicable to categorical analysis.
Conclusions: These results demonstrate that an overwhelming portion of perioperative POCUS research is performed from the anesthesiology perspective with a focus on assessing gastric content and cardiopulmonary function for appropriate surgical timing and postoperative ICU care, respectively. Future research by hospitalists should focus on clinical questions that can be answered with POCUS for preoperative medical evaluation and non-ICU postoperative care in the less-controlled environment of hospital wards.